Inhibitors of Angiotensin II in Proteinuric Mesangioproliferative Glomerulonephritis

Long-term Treatment by Inhibitors of Angiotensin II at Low Doses in Non-nephrotic Proteinuric Patients With Pauciimmune and IgA Mesangioproliferative Glomerulonephritis

This study evaluates prospectively the effects of an anti-angiotensin II regimen on renal outcome in patients with mesangioproliferative glomerulonephritis followed-up for 10 years.

After signing informed consent, enrolled patients started treatment with ACEi. We decided to prescribe to all patients the same drug (ramipril) at the same dosage (5 mg/day). All patients were examined every 2 months during the first year of follow-up and every 6 months thereafter. At each visit, they underwent a complete physical examination. If the target blood pressure of <140/90 mmHg was not achieved with ramipril monotherapy, addition of other antihypertensive drug(s) was allowed. Patients complaining adverse side effects attributed to ramipril were switched to losartan (50 mg/day). The patients were also prescribed a normal protein (1 gram/kg/day) and moderately salt-restricted (6-8 grams/day) diet throughout the study.

Inclusion Criteria:

• proteinuria ≥ 1 g and < 3 g/24 hours stable during the 3 months of run-in
• microscopic hematuria (with at least 10 red blood cells per high-power field), without other signs or symptoms of systemic diseases stable during the 3 months of run-in
• no-evidence of renal failure or other relevant diseases
• biopsy diagnosis of I-II stage IgA- or pauciimmune-MsPGN

Exclusion Criteria:

• estimated Glomerular Filtration Rate (eGFR) <80 ml/min/1.73m2
• previous immunosuppressive treatment
• blood pressure (BP) >150/90 mmHg